Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, The Netherlands.
Catheter Cardiovasc Interv. 2011 Mar 1;77(4):484-91. doi: 10.1002/ccd.22664.
This study evaluated the impact of a chronic total occlusion (CTO) in a non-infarct related coronary artery (IRA) on markers of reperfusion, infarct size, and long-term cardiac mortality in patients with ST-elevation myocardial infarction (STEMI).
A concurrent CTO in STEMI patients has been associated with impaired left ventricular function and outcome. However, the impact on markers of reperfusion is unknown.
All 1,071 STEMI patients included in the TAPAS-trial between January 2005 and December 2006 were used for this substudy. Endpoints were the association between a CTO in a non-IRA and myocardial blush grade (MBG) of the IRA, ST-segment elevation resolution (STR), enzymatic infarct size, and clinical outcome.
A total of 90 patients (8.4%) had a CTO. MBG 0 or 1 occurred more often in the CTO group (34.2% versus 20.6% (Odds Ratio [OR] 2.00, 95% confidence interval [CI]: 1.22-3.23, P = 0.006)). Incomplete STR occurred more often in the CTO group, (63.6% versus 48.2% [OR 1.96, 95% CI: 1.22-3.13, P = 0.005]). Median level of maximal myocardial-band of creatinin kinase (CK-MB) in the CTO group was 75 μg/l (IQR 28-136) and 51 μg/l (IQR 18-97) in the no-CTO group (P = 0.021). The presence of a CTO in a non-IRA in STEMI patients was an independent risk factor for cardiac mortality (HR 2.41, 95% CI: 1.26-4.61, P = 0.008) at 25 months follow-up.
A CTO in a non-IRA is associated with impaired reperfusion markers and impaired long-term outcome in STEMI patients.
本研究评估了非梗死相关冠状动脉（IRA）中的慢性完全闭塞（CTO）对 ST 段抬高型心肌梗死（STEMI）患者再灌注标志物、梗死面积和长期心脏死亡率的影响。
STEMI 患者同时存在 CTO 与左心室功能和预后受损有关。然而，其对再灌注标志物的影响尚不清楚。
本研究纳入了 2005 年 1 月至 2006 年 12 月 TAPAS 试验中的 1071 例 STEMI 患者，进行了这项亚组研究。终点是 IRA 中的 CTO 与心肌染色分级（MBG）、ST 段抬高缓解（STR）、酶性梗死面积和临床结局之间的关联。
共有 90 例（8.4%）患者存在 CTO。CTO 组 MBG 0 或 1 级的发生率更高（34.2%比 20.6%，优势比[OR]为 2.00，95%置信区间[CI]：1.22-3.23，P = 0.006）。CTO 组不完全 STR 的发生率更高（63.6%比 48.2%，OR 为 1.96，95%CI：1.22-3.13，P = 0.005）。CTO 组最大肌酸激酶同工酶（CK-MB）中位数为 75μg/l（IQR 28-136），无 CTO 组为 51μg/l（IQR 18-97）（P = 0.021）。STEMI 患者非 IRA 中的 CTO 是 25 个月随访时心脏死亡率的独立危险因素（HR 2.41，95%CI：1.26-4.61，P = 0.008）。
非 IRA 中的 CTO 与 STEMI 患者再灌注标志物受损和长期预后不良相关。
